Public reporting measures don't give full patient safety picture

Common indicators used to rate hospital safety may not accurately capture care quality, a new study suggests.

The research, which comes from Johns Hopkins Armstrong Institute for Patient Safety and Quality and was published in Medical Care, finds that just one out of 21 measures met the criteria for being a true indicator of hospital safety. A number of public rating systems use these guidelines, including Leapfrog's Hospital Safety Score and the Centers for Medicare & Medicaid Services' Star Ratings.

"These measures have the ability to misinform patients, misclassify hospitals, misapply financial data and cause unwarranted reputational harm to hospitals," Bradford Winters, M.D., Ph.D., associate professor of anesthesiology and critical care medicine at Johns Hopkins and lead study author said in the study announcement. "If the measures don't hold up to the latest science, then we need to re-evaluate whether we should be using them to compare hospitals."

The researchers analyzed data from 19 studies published between 1990 and 2015 which questioned the validity of common patient safety indicators and hospital-acquired condition figures. Much of the data collected on those two points is from hospital billing data rather than clinical data, which can cause significant differences in how hospitals code errors, the study team wrote.

Of the 21 measures examined, the team found that 16 had insufficient data and could not be evaluated for validity. Of the five that the team could study, only one, which measures accidental punctures or lacerations caused during surgery, met the researchers' criteria.

The team's goal, they wrote, is to encourage public rankings to use clinical data rather than data from hospital billing.

"The variation in coding severely limits our ability to count safety events and draw conclusions about the quality of care between hospitals," Peter Pronovost, M.D., Ph.D., another study author and director of the Armstrong Institute said in the announcement. "Patients should have measures that reflect how well we care for patients, not how well we code that care."

A recent study published in The BMJ also suggests that better ways to code medical errors could help prevent future safety issues, FierceHealthcare previously reported. The study suggested such errors account for 250,000 deaths a year, the nation's third leading cause of death.

To learn more:
- here's the study
- read the announcement